The Legitimation and Regulation of DNR Orders

Abstract

In July 1987, the New York State Legislature amended the State’s public health law to regulate “Do Not Resuscitate” orders, effective April 1, 1988 [23]. There immediately ensued a controversy over the limits the law placed on the physician’s power to write medical orders “not to resuscitate” patients. Physicians’ prerogatives in life-and-death decisions had been a subject of debate for over two decades. Bioethicists hold that there is but one legitimate answer to the question: Who shall decide whether to initiate or forego life-sustaining medical interventions? — The patient. The life in question belongs to the patient, not the physician; hence decisions concerning that life properly belong to the patient, not to the physician. To quote from the authoritative 1983 report of the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research:

Respect for the self-determination of competent patients is of special importance in decisions to forego life-sustaining treatment because different people will have markedly different concerns during the final period of their lives.… [Therefore] the primacy of a patient’s interests in self-determination and in honoring the patient’s own view of wellbeing warrant leaving the patient with the final authority to decide ([40], p. 44).